The Plot Against the NHS by Colin Leys and Stewart Player – book review
Read this book and get very angry. It shows very clearly how private capital in the form of health care multinationals, giant international consultancies and private equity companies have used their highly-paid agents, bureaucratic stooges, hireling politicians and other placemen to plan and implement the destruction of the NHS as a universal service, free at the point of use. Leys and Player demonstrate from today’s perspective that a sometimes apparently random set of policies, decisions and actions from 1999 were no such thing, but part of a long-term plan to privatise the NHS, and that the ConDem Coalition’s Health and Social Security Bill is the inevitable consummation of this process.
The book has a gripping narrative, tracing what it calls the marketisation of the NHS from Labour’s 2000 NHS Plan, and the concordat with the private health care ‘to make private companies permanent providers of treatment to NHS patients’ (p1). The lead negotiator for health care capital was Tim Evans, who said he looked forward ‘to a time when the NHS would simply be a kitemark attached to the institutions and activities of a system of purely private providers’ (cited p1). Should Health Secretary’s Andrew Lansley’s Bill be passed, that time will soon arrive – unless there is real popular resistance.
Leys and Player speak of a ‘plot’ since at no point has there been any open acknowledgement of what was being enacted during this time. Successive Labour health secretaries – in particular Alan Milburn and Patricia Hewitt – constantly and publicly lied through their teeth as they denied that their evolving policies were about privatisation. By their deeds shall ye know them, and their subsequent careers as highly-paid advisers to private equity companies involved in health care business, to private healthcare providers and to pharmacy companies demonstrates their true allegiance. Truly hireling politicians!
Leys and Player introduce us to the key players: not just the venal Labour Health Secretaries, but the agents of change as they waltzed between Number 10, the Department of Health (DoH), health care companies and private consultancies. There is Penny Dash, author of the NHS Plan, Director of Strategy at the DoH, ex-Kaiser Permanante (a major US health care organisation), who seems ubiquitous, helping as a partner in McKinsey to formulate the 2009 report which proposed ways of saving £20bn in the NHS, a report publicly disowned by the DoH but whose target savings then became miraculously those of the Labour government before its demise. There is Simon Stephens, architect of the ‘reforms’, adviser to both Tony Blair and Alan Milburn, now President of Global Health of the huge multinational UnitedHealth, who boasts of his role in undermining President Obama’s very modest health care reforms and ensuring that they favoured private health care insurers. Another is Mark Britnell, ex-DoH Head of Commissioning, who commissioned the McKinsey report and is now head of Global Health at KPMG. The door between the Department of Health and private consultancies and health care providers was in a state of constant revolution.
Perhaps the most notorious now is Ken Anderson who was made Director General of a new DoH Commercial Directorate with the brief of ‘introducing independent sector providers to the NHS’ (p15). By 2006 the directorate had 190 people, 182 of them management consultants on £1,000-£2,000 per day each. It was Anderson who launched the Independent Sector Treatment Centre (ISTC) programme which took £5.6bn over five years from the NHS (p17) and gave it to private companies on extraordinarily generous guaranteed contracts. Later in the book the authors state that ‘Healthcare markets offer huge scope for fraud and other kinds of malpractice’ (p129) and cite numerous examples from the
The book analyses the key landmarks in the ‘marketisation’ of the NHS: the introduction of Foundation Trusts; the ISTC programme and the establishment of the tariff for hospital operations. They suggest that the new contract for GPs which allowed them to give up out-of-hours care was in fact a ploy to set up yet another entry point for private companies in supplying out-of-hours services. Then there is the development of the ‘world class commissioning’ programme from 2006, designed by McKinsey with the aim of getting health care insurers to manage the purchase of healthcare under contract to Primary Care Trusts. There was a bit of a spat when prospective bidders for the DoH contracts cried foul on McKinsey since it wanted a slice of the action it was specifying.
All these steps were not just laying the foundations of a privatised NHS, but building the walls as well, way before the ConDem coalition came to office in 2010. The process was accompanied by deception and obfuscation, by the withholding of crucial information on the basis that it was ‘commercial in confidence’. Policy documents used an entire thesaurus of euphemisms – ‘contestability’, ‘plurality of providers’, ‘independent sector’ to disguise the reality of competition and privatisation. It was sanctioned by the two leading and supposedly independent health care ‘think tanks’, the Kings Fund and the Nuffield Trust. This ‘independence’ is spurious: the Kings Fund board of trustees includes Simon Stevens and Penny Dash. Its Chief Executive is Chris Ham, a ‘tireless promoter of Kaiser Permanante’ (p97) who is also on the board of the Nuffield Trust along with the McKinsey head of European health.
Leys and Player are clear about the consequences of privatisation: a ‘three-tier health system – an increasingly basic NHS service; NHS services topped up with either private services, or fee-paid additional NHS care; and fully private services’ (p141). They give examples of how this happening already: PCT rationing of certain operations such as varicose veins, hip and knee replacement, cataracts. And even if they do not spell it out, the current round of cuts is clearly helping to de-stabilise the NHS and drive some hospitals to the wall, providing yet more openings for private health care companies.
The story that Leys and Player tell has its origin in the crisis of profitability which since the 1970s has forced capital to constantly search for new sources of profit. This has underpinned the whole programme of privatisation. Selling off nationalised industries was the first step, followed by the utilities, but this has not been enough. Now health and education have to follow suit to meet capital’s unquenchable thirst for profit. It tells us two things: first, that a state-funded and state-run health service meeting the needs of the working class has only proved possible for a short and exceptional period in capitalism’s life, and second, that the privatisation of health care is a class issue. For this reason we have to take up Leys and Player’s challenge: the fight to save the NHS as a nationalised service is critical for the working class today.
Colin Leys and Stewart Player: The Plot Against the NHS. Merlin Press 2011, 179pp £10.00